The purpose of the study is to assess power Doppler ultrasounds for demonstrating autoregulatory disparities predicting neonatal hemorrhage- ischemic changes. We have tested nine infants ranging in age from 24 to 30 gestational weeks (mean, 27 weeks) who underwent at least two power Doppler neurosonographic examinations in the first week of life, with a 7.0 MHz arterial sector probe. Color, gate, scale, and power setting gains were standardized and coronal images were assessed subjectively for increased/asymmetric flow. Color hard copies were digitized with a Hewlett-Packard image digitizer, lateral basal ganglia region-of- interest calculations were performed with an NIH image processor and digitizer program and minimum value thresholds were established to show the lateral lenticulostriates. Bright and dark pixel counts and area average ratios were performed. Measurements were compared with eventual clinical outcome. Three of the neonates with germinal matrix hemorrhage showed subjectively unappreciated prehemorrhage elevated flow decreasing to normal following hemorrhage. Two neonates with increased intensity developed PVL. Only one neonate with elevated intensity had a normal course. We conclude that power Doppler helps predict hemorrhage-ischemic changes that may be the results of altered autoregulation. Image digitization with objective region-of-interest measurement significantly increases sensitivity.